On my own terms: Motivations for self-treating opioid-use disorder with non-prescribed buprenorphine

• Published in: Drug and alcohol dependence 2020-05, Vol.210, p.107958-107958, Article 107958
• Main Authors: Silverstein, Sydney M., Daniulaityte, Raminta, Miller, Shannon C., Martins, Silvia S., Carlson, Robert G.
• Format: Article
• Language: English
• Subjects: Adult; Analgesics, Opioid - therapeutic use; Buprenorphine; Buprenorphine - therapeutic use; Buprenorphine diversion; Drug addiction; Drug overdose; Drug Overdose - drug therapy; Drug Overdose - epidemiology; Drug Overdose - psychology; Drug therapy; Female; Humans; Interviews; Longitudinal Studies; Male; Medical treatment; Metropolitan areas; Middle Aged; Motivation; Motivation - physiology; Narcotics; Natural history; Non-prescribed buprenorphine; Ohio - epidemiology; Opiate Substitution Treatment - methods; Opiate Substitution Treatment - psychology; Opioid use disorder; Opioid-Related Disorders - drug therapy; Opioid-Related Disorders - psychology; Opioids; Opting out; Overdose; Pharmacology; Qualitative Research; Recovery; Relocation; Self Care - methods; Self Care - psychology; Self determination; Self-medication; Self-treatment; Substance use; Substance use disorder; Treatment avoidance
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2020.107958

•Use of non-prescribed buprenorphine (NPB) is used as a self-treatment modality among people who use illicit opioids.•People with opioid-use disorder sometimes opt to self-treat with NPB despite growing accessibility of treatment options.•Motivations for self-treatment with NPB are complex and include both structural and personal factors.•Use of NPB may transition into sustained recovery episodes or enrollment in formal treatment. The opioid overdose crisis in the United States has prompted an expansion of treatment services, including pharmacotherapy with buprenorphine. However, many people who use illicit opioids (PWUIO) self-treat their opioid-use disorder (OUD) with non-prescribed buprenorphine (NPB) in lieu of attending formal treatment. The present study aims to qualitatively understand motivations of people who are self-treating their OUD with NPB. Qualitative study designed to supplement and contextualize quantitative findings from natural history study of buprenorphine diversion, self-treatment, and use of substance use disorder treatment services. Interviews were audio-recorded, transcribed, systematically coded and analyzed via Iterative Categorization. The Dayton, Ohio metropolitan area in the midwestern United States; a site previously characterized as high impact in the national opioid overdose crisis. Sixty-five individuals (35 men and 30 women) who met the DSM-5 criteria for OUD (moderate or severe) and had used NPB at least one time in the six months prior to their intake interview. Participants described four key motivators for self-treating with NPB: perceived demands of formal treatment, the desire to utilize non-prescribed buprenorphine in combination with a geographic relocation, to self-initiate treatment while preparing for formal services, and to bolster a sense of self-determination and agency in their recovery trajectory. Use of NPB is a recognized self-treatment modality among PWUIO, with some PWUIO transitioning into sustained recovery episodes or enrollment in formal treatment. Understanding the motivations for opting out of treatment is crucial for improving forms of care for people with OUD.